AFFECTIVE DISORDERS AND QUALITY OF LIFE IN PATIENTS WITH CORONARY HEART DISEASE ACCORDING TO PSYCHOMETRIC TESTS DATA

The aim was to study the frequency and severity of affective disorders and quality of life in patients with coronary heart disease (CHD): unstable and stable angina of II–III functional class.

Materials and methods. 488 patients with verified CHD were examined to identify and assess anxiety-depressive spectrum disorders by the screening questionnaire of Moscow Research Institute of Psychiatry, Ministry of Health of Russia. 172 patients with CHD from the screening group – 96 (55.81 %) patients with unstable angina and 76 (44.19 %) with stable angina, 136 (79.07 %) men and 36 (20.93 %) women were examined with psychometric tests: Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Modified Seattle Angina Questionnaire (SAQ) was used to study quality of life. Excel and Statistica 6.0 programs were used to assess statistical process of the material.

Results. According to the screening questionnaire, in screening group of patients with CHD (n = 488) the symptoms of anxiety-depressive disorder were present in 398 (81.56 %) patients, in 90 patients (18.44 %) they were absent (p <0.0001). In the group of patients with CHD examined by psychometric tests (n = 172), the symptoms of anxiety-depressive disorder according to the screening questionnaire were revealed in 137 (79.65 %) patients, in 35 (20.35 %) patients they were absent (p <0.0001). The severity of depression symptoms according to BDI scale (17.11 ± 9.38 vs. 12.73 ± 8.1 points; p <0.04) and the symptoms of anxiety-depressive disorder according to the screening questionnaire were noted more often (p <0.0008) in patients with unstable angina compared with stable angina – in 85 (88.54 %) vs. 52 (68.42 %) patients (р <0.0008). In the group of patients with stable angina the level of depression according to BDI scale in patients taking pharmacological treatment was higher in comparison with the patients who underwent myocardial revascularization (14.56 ± 9.0 vs. 10.03 ± 6.13 points; p <0.01). Quality of life parameter according to modified SAQ was statistically significantly decreased in the subgroups of patients with increasing severity of depression symptoms according to BDI scale (10–63 points) compared with the subgroup of patients with no depression (0–9 points).

Conclusion. According to the screening questionnaire, a high incidence of anxiety-depressive disorder was found in patients with CHD. The symptoms of anxiety-depressive disorder and the severity of depression symptoms according to BDI scale were noted more often in the group of patients with unstable angina compared with the group of patients with stable angina. Quality of life parameter according to modified SAQ was statistically significantly reduced with increasing severity of depression symptoms according to BDI scale in subgroup of patients with symptoms of depression compared with the subgroup of patients without depression. According to the results of the study the BDI scale is more sensitive for the diagnosis of depression than the HADS scale.

coronary heart disease, screening, anxiety, depression, quality of life, unstable angina, stable angina, BDI scale, HADS scale, modified Seattle Angina Questionnaire

1. Authors/Task Force Members: Piepoli M.F., Hoes A.W. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016;252:207–74. DOI: 10.1016/j.atherosclerosis.2016.05.037. PMID: 27664503.

2. Perk J., De Backer G., Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33(13):1635–701. DOI: 10.1093/eurheartj/ehs092. PMID: 22555213.

3. Lichman J.H., Froelicher E.S., Blumenthal J.A. et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations. A scientific statement from the American Heart Association. Circulation 2014;129(12):1350–69. DOI: 10.1161/cir.0000000000000019.

4. Chazov E.I., Boitsov S.A. Ways to reduce cardiovascular mortality in the country. Kardiologicheskij vestnik = Cardiology Herald 2009;4 (1):5–10. (In Russ.)

5. Pogosova N.V., Baychorov I.Kh., Yufereva Yu.M., Koltunov I.E. Quality of life in patients with cardiovascular diseases: modern state of the problem. Kardiologiya = Cardiology 2010;50(4):66–78. (In Russ.)

6. The health of the population and activities of healthcare organizations of the Kyrgyz Republic in 2015. Bishkek, 2016. (In Russ.)

7. Vasyuk Yu.A., Lebedev A.V., Dovzhenko T.V., Semiglazova M.V. Affective disorders in acute myocardial infarction and possibilities of their correction by tianeptine. Terapevticheskij arhiv = Therapeutic Аrchive 2010;82(10): 28–33. (In Russ.)

8. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6):361–70.

9. Beck A.T., Ward C.H., Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.

10. Zalesskaya Yu.V., Noruzbaeva A.N., Mirrakhimov E.M. Assessment of life quality in patients with coronary heart disease and hyperlipidemia, trained in special educational programs. Central’no-aziatskij medicinskij zhurnal = Central Asian Medical Journal 2002;2 (8):189–93. (In Russ.)

11. Belyalov F.I. Depression, anxiety and stress in patients with coronary heart disease. Terapevticheskij arhiv = Therapeutic Аrchive 2017;89(8):104–9. (In Russ.) DOI: 10.17116/terarkh2017898104-109.

12. Frassure-Smith N., Lesperance F. Depression and anxiety as predictor of 2-years cardiac events in patients with stable coronary disease. Arch Gen Psychiatry 2008;65(1):62–71.

13. Szpakowski N., Bennell M.C., Qiu F. et al. Clinical impact of subsequent depression in patients with a new diagnosis of stable angina: a population-based study. Cir Cardiovasc Qual Outcomes 2016;9(6):731–9. DOI: 10.1161/CIRCOUTCOMES.116.002904. PMID: 27703034.

14. Lespérance F., Frasure-Smith N., Juneau M., Théroux P. Depression and 1-year prognosis in unstable angina. Arc Intern Med 2000;160(9):1354–60. PMID: 10809041.

15. Buryachkovskaya L.I., Polyakova E.O., Sumarokov A.B. The effect of depressive disorders on the development and outcome of cardiovascular diseases. Terapevticheskij arhiv = Therapeutic Аrchive 2006;78 (11):87–92. (In Russ.)

16. Andryuschenko F.V., Drobizhev M.Yu., Dobrovolskiy A.V. Comparative evaluation of CES-D, BDI and HADS (d) scales in the diagnosis of depression in general medical practice. Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova = Journal of Neurology and Psychiatry named after SS. Korsakov 2003;103(5):11–7. (In Russ.)

17. Tsygankov B.D., Malygin Ya.V., Dobrovolskaya Yu.V., Hannanova A.N. Psychometric assessment capabilities of comorbid anxious and depressive disorders (foreign literature review). Zhurnal nevrologii i psihiatrii imeni S.S. Korsakova = Journal of Neurology and Psychiatry named after S.S. Korsakov 2009;109(6):91–4. (In Russ.)]

18. Sorensen C., Fris-Hasche E., Hadhfelt T., Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychother Psychosom 2005;74(2):69–80. DOI: 10.1159/000083165. PMID: 15741756.